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All Journal Jurnal Anestesiologi Indonesia MEDICINUS
Muhammad Rizqhan
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Thoracic Spinal Anesthesia (TSA) in Patients with Congestive Heart Failure and Pleural Effusion Undergoing Breast Tumor Surgery: A Case Report Wiedjaja, Aryasena Andhika; Rizqhan, Muhammad
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 2 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.67321

Abstract

Background: Thoracic spinal anesthesia (TSA) is a regional anesthesia technique that can serve as an alternative to general anesthesia, particularly for patients with cardiovascular and respiratory comorbidities, to reduce adverse effects and provide a more effective procedure.Case: A 55-year-old female patient with a left breast tumor and comorbidities including uncontrolled hypertension and type 2 diabetes mellitus, as well as congestive heart failure (CHF) and bilateral pleural effusion, scheduled for lumpectomy by a surgical specialist. The preoperative assessment showed stable hemodynamics with no significant changes in laboratory results. The patient received hyperbaric bupivacaine 5 mg (1cc), fentanyl 25 mcg (0.5cc), and an adjuvant of dexamethasone 5 mg (1cc) for the TSA procedure at the T4-T5 level. Intraoperatively, there were no significant hemodynamic changes, and postoperatively, the patient had a good recovery and mobilization.Discussion: The TSA procedure is an alternative anesthesia technique when patients undergoing general anesthesia have a high risk of morbidity and mortality, especially in geriatric patients with physiological body disorders and multiple comorbidities. TSA has been increasingly used as a safe anesthesia technique, capable of accelerating recovery time, minimizing side effects, and providing better outcomes in terms of perioperative morbidity and mortality compared to general anesthesia. The current limitations of the literature regarding TSA include the lack of large-scale studies, the absence of standardized protocols for TSA, a focus on specific surgeries only, and concerns about the safety of this procedure.Conclusion: The TSA can be used as a regional anesthesia procedure for patients undergoing breast tumor surgery. TSA has a simple technique and is efficient in providing sensory and motor blockade.
Critical Care of Eclampsia with Partial HELLP Syndrome in Resource-Limited Setting: A Case Report Rizqhan, Muhammad; Wiedjaja, Aryasena Andhika
MEDICINUS Vol. 38 No. 9 (2025): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/3d3d3g27

Abstract

Background: Eclampsia is a hypertensive disorder of pregnancy characterized by life-threatening seizures and often requires intensive care among obstetric patients. HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome is a complication of hypertensive disorders in pregnancy, marked by hemolysis, elevated liver enzymes, and thrombocytopenia. Developing countries have high maternal mortality rates due to inadequate antenatal maternal care services.Case Report: Mrs. D, 25 years old, married, a housewife, was referred to the emergency unit of Encik Mariyam Regional Hospital, Lingga, with seizures and decreased consciousness for the past 3 hours prior to admission. The patient wasdiagnosed with eclampsia complicated by partial HELLP syndrome and was scheduled for an emergency cesarean section (SC) by the obstetrician. General anesthesia was administered, and the patient received care in the intensive care unit (ICU) for 5 days under resource-limited conditions.Conclusions: Maternal mortality due to eclampsia and HELLP syndrome accounts for a significant proportion, especially in developing countries. Early diagnosis and prompt treatment by the ICU team can prevent complications and reduce morbidity and mortality. Emerging complications require early multidisciplinary intervention and treatment, including ventilator support, intensive monitoring, and the use of vasoactive medications, all of which can mitigate the progression of organ dysfunction and improve prognosis.
Anesthesia for ASD Closure in Robotic-Assisted Cardiac Surgery: A Case Report Rizqhan, Muhammad; Hadinata, Yudi
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.70958

Abstract

Background: Minimally invasive cardiac surgery (MICS) utilizes small chest incisions without sternotomy, offering faster recovery, reduced physiological stress, shorter hospitalization, and better cosmetic results. Robotic-assisted surgery is a modern approach within MICS that provides enhanced precision. However, literature on anesthesia management in robotic-assisted atrial septal defect (ASD) closure remains limited. This case report aims to provide clinical insights and support the safe adoption of such techniques.Case: A 51-year-old male with an ASD secundum and a left-to-right (L-R) shunt measuring 22x29 mm, without comorbidities, was scheduled for general anesthesia. The patient was classified as American Society of Anesthesiologists (ASA) physical status III. Monitors applied included electrocardiogram (ECG), nasopharyngeal thermometer, arterial line, central venous pressure (CVP), EtCO₂, near-infrared spectroscopy (NIRS), and transesophageal echocardiography (TEE). The patient was placed in a supine position and intubated with a 37 Fr left-sided double-lumen endotracheal tube (DLT) at a depth of 31 cm, followed by one-lung ventilation. General anesthesia was induced using midazolam 5 mg, sufentanil 10 mcg, propofol 50 mg, and rocuronium 50 mg, maintained with 1% sevoflurane and rocuronium at 10 mg/hour. A regional block was performed using a deep serratus anterior plane block (DSAPB) with a regimen of 10 ml of 0.5% isobaric bupivacaine (50 mg), 5 ml of 10% lignocaine (500 mg), and epinephrine 1:200,000, with a total volume of 40 ml. The surgery was performed on a beating heart with right femoral artery, right femoral vein, and right jugular vein cannulation. The procedure lasted 12 hours.Discussion: Robotic-assisted cardiac surgery enhances surgical accuracy but presents unique anesthetic challenges due to patient positioning, limited access, and cardiopulmonary dynamics. Anesthesiologists must optimize monitoring and maintain close team coordination.Conclusion: Robot-assisted MICS represents a significant advancement in MICS. However, anesthesiologists must pay close attention to preoperative, intraoperative, and postoperative assessments to ensure patient safety and optimal outcomes.
Co-Authors Wiedjaja, Aryasena Andhika Yudi Hadinata